An unusual cause of chest pain

doi:10.1136/bmj.b3004

Published 12 August 2009, doi:10.1136/bmj.b3004
Cite this as: BMJ 2009;339:b3004

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An unusual cause of chest pain

Madhuchanda Bhattacharyya, specialist registrar, Minaxi Dattani, specialist registrar

¹ Department of Radiology, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ

Correspondence to: M Bhattacharyya madhuchanda_b@hotmail.com

The first 150 words of the full text of this article appear below.

A 66 year old woman presented to the accident and emergencydepartment with severe chest pain radiating to the back followingseveral episodes of vomiting after a meal.

On examination, she was unwell with tachycardia and tachypnoea.Her blood pressure was 150/80 mm Hg in the left arm and 138/80mm Hg in the right arm. Her past medical history included asthma,hypertension, and a previous transient ischaemic attack.

On admission, she had a mildly raised white blood cell count(14.3x10⁹/l) with neutrophilia (8.58x10⁹/l) and normal haemoglobin(143 g/l). Serum lactate was raised (3.6 mmol/l), but urea andelectrolytes were normal. Chest radiography was performed andshowed a right sided pleural effusion. Aortic dissection wassuspected, and she underwent computed tomography of the chest,abdomen, and pelvis using an aortic protocol. The scan showeda pneumomediastinum with an associated pneumothorax and a rightsided . . . [Full text of this article]